Association of obesity with venous thromboembolism and myocardial injury in COVID-19

Abstract

Introduction Although both obesity and coronavirus disease 2019 (COVID-19) independently induce inflammation and thrombosis, the association between obesity class and risk of thrombosis in patients with COVID-19 remains unclear. Methods This retrospective cohort study included consecutive patients hospitalized with COVID-19 at a single institution. Patients were categorized based on obesity class. The main outcomes were venous thromboembolism (VTE) and myocardial injury, a marker of microvascular thrombosis in COVID-19. Adjustments were made for sociodemographic variables, cardiovascular disease risk factors and comorbidities. Results 609 patients with COVID-19 were included. 351 (58%) patients were without obesity, 110 (18%) were patients with class I obesity, 76 (12%) were patients with class II obesity, and 72 (12%) were patients with class III obesity. Patients with class I and III obesity had significantly higher risk-adjusted odds of VTE compared to patients without obesity (OR = 2.54, 95% CI: 1.05–6.14 for class I obesity; and OR = 3.95, 95% CI: 1.40–11.14 for class III obesity). Patients with class III obesity had significantly higher risk-adjusted odds of myocardial injury compared to patients without obesity (OR = 2.15, 95% CI: 1.12–4.12). Both VTE and myocardial injury were significantly associated with greater risk-adjusted odds of mortality. Conclusion This study demonstrates that both macrovascular and microvascular thromboses may contribute to the elevated morbidity and mortality in patients with obesity and COVID-19.

Determinants of endothelial dysfunction in noncritically ill hospitalized COVID‐19 patients: A cross‐sectional study

“…For example, in a retrospective study on 7,606 patients hospitalized with COVID‐19, the presence of obesity was found to be associated not only with an increased risk of in‐hospital death, but also with a high risk of venous thromboembolism (33). Similar evidence was found in a retrospective cohort of 609 patients hospitalized for COVID‐19, in which class I and III subgroups of patients with obesity had significantly higher risk‐adjusted odds of venous thromboembolism compared with patients without obesity (34).…”

Risk Factors of Venous Thromboembolism in Noncritically Ill Patients Hospitalized for Acute COVID-19 Pneumonia Receiving Prophylactic-Dose Anticoagulation

“…The most prevalent blood groups in our study population were O (n = 85, 41%) and A (n = 83, 40%). The cases were significantly younger (71 (61-81) vs. 78 (69-86) years, p = 0.004), and more obese (BMI 29 (27)(28)(29)(30)(31) vs. 26 (23)(24)(25)(26)(27)(28)(29), p = 0.002) than the controls. The Padua Prediction Score was significantly lower in patients who developed VTE (3 (2-3) vs. 4 (3-6), p = 0.03).…”

“…The median age was 77 (66-86) years; 110 patients (53%) were female and 98 (47%) were male. The median Body Mass Index (BMI) was 26 (23)(24)(25)(26)(27)(28)(29)(30)(31). The most frequent comorbidity was arterial hypertension (n = 131, 63%), followed by chronic kidney disease (n = 43, 21%) and diabetes (n = 39, 19%).…”

Strength of Anticoagulation in Moderate to Severe COVID-19 Illness: In Medio Stat Virtus?

“…Importantly, unlike assessing the risk of VTE in the general population, the use of conventional predictive scores (e.g., Geneva, Wells, CHADS2/CHA2DS2VASc/M-CHA2DS2VASc and CHOD among others) does not yield satisfactory predictive performance in patients with COVID-19, as clearly highlighted in the systematic literature review published by Rindi et al, 20 thus underpinning the need to develop specific risk assessment models in COVID-19. Additional factors that may also enhance the risk of developing venous thrombosis in patients with SARS-CoV-2 infection are pre-existing pulmonary disorders, 21 obesity, 22 and, last but not least, prothrombotic mutations. 23 Obesity, D-dimer, blood lactate, CRP, and neutrophil count were also found to be independent predictors of venous thrombosis in an analysis of the COVID-19 Brazilian Registry.…”